Homebirth midwives - breastfeeding question

[BeckiCNM]

Do you require your clients to breastfeed? If so, for how long? Immediately postpartum? Two weeks? Six weeks?

Is not breastfeeding for whatever reason (including true medical contraindications or inability to breastfeed) a reason to "risk out" of home birth?

Curious as to your thoughts....

[nashvillemidwife]

I can't say I'd risk someone out, but I'd be concerned about ability to control bleeding once I'm gone. It's not like in the hospital where you've got a nurse coming by to check on you every hour and give pitocin if they start bleeding heavily. Once I'm gone I rely on the mom to nurse the baby regularly. So I guess even if they don't plan to "breastfeed" I'd be leery of someone not willing to put the baby on the breast in the first day postpartum.

[JunipersMom]

I have right in my beginning paperwork that I will not work with a family that is not committed to breastfeeding at least as long as in my care (6 weeks postpartum). It's so so so very important to me that I work very hard to keep mom and babe healthy - in and out of the uterus.

[MsBlack]

I require a min. 2wk BF committment (with strong encouragement to continue!), because I too want to feel sure that bleeding is controlled and involution is well underway once I'm not there after the birth--not to mention that I just think it is so important for the baby, and bonding, too. Never had a woman refuse this, so far my clients have all wanted to breastfeed for as long as possible (and only a couple have quit in a few months due to issues of one kind or another).

Can't say I would 'risk someone out' (tho I would surely explain the risks of homebirth w/out bf-ing, blood loss and so forth). I do think if someone just didn't want to bf for at least 2wks, then I would tell them that I couldn't work with them--that we weren't a good fit. Exception would be someone otherwise healthy but who actually could not bf--which kind of woman would be pretty rare I guess. Then I think we could find med backup to make sure mom had something in pill form to promote involution.

[Robinna]

how often do you run into a mama who wants a homebirth who doesn't want to bf, though? It seems utterly linked, to me. I'm very sheltered though.

[mwherbs]

taken situation by situation-- it rarely comes up-- I have more concerns than bleeding-- bonding and baby's health are some other things most of our gals do not see docs and very often they don't take their babies in either even though we recommend it and it is in the paperwork -- I would insist if the baby weren't nursing that the baby goes in to see someone who has more experience with formula ...
one client that comes to mind- sexual abuse survivor -- she did try nursing for the first few days-- but was clear it wasn't going to be ok...at that point in time .

[Georgetown HB Mom]

I am a midwife student, will be taking my certification exams next year. I also had a home birth almost three years ago. I did not BF at all. It was best for me to formula feed. Also, there are other ways to control bleeding. BF is not the only way. Whether or not to BF is a very personal choice and I don't think anyone should be turned away from a midwife because they do not want to BF. Also, I have two daughters and I have bonded just fine with them. I take very personal offense when women say you can not bond with your child if you don't BF them. The baby does not know where it is suppose to receive food, all it knows is that it is hungry and wants to be held close, loved and fed. I will not "require" any of my clients to BF. I had a wonderful midwife when I had my homebirth who completely supported my decision, never tried to change my mind and was not at all concerned about how to control bleeding, she knew how to control it if it should happen without BF.

Lisa

[doctorjen]

Hmm, I think babies actually do know where they are supposed to get their food. Babies are born with many natural skills to aid them in seeking the breast and getting milk. Birthing and then putting baby to breast are the biologic norm, and breastfeeding works naturally to reduce blood loss after birth, contract the uterus, assist the baby is passing it's meconium, etc. I understand why a homebirth midwife in particular might feel strongly about it. I don't think anyone said you can't bond if you don't breastfeed, merely that breastfeeding fosters the bond and is the biologically normal way that mothers and babies get to know each other.
In my own practice (which is hospital based, of course) I don't have the option really of telling people I won't care for them if they don't breastfeed. I do work hard at encouraging them, though, and have much higher initiation and continuation rates than the other docs in the community.
I have a client right now who had her last baby at home but is birthing in hospital with me this time due to insurance issues. I was absolutely flabbergasted at our first interview when she told me about her birth plans - she doesn't want to touch or see the baby until it's "cleaned up" and wrapped and no breastfeeding at all. She wants the baby carried away directly and brought back washed and wrapped. I don't think I've ever met someone who planned a natural birth, much less a homebirth, who didn't want to even see the baby right after!

[MsBlack]

georgetown--

I don't think anyone said, or believes, that bonding 'can't happen' w/bottle feeding; I think it was expressed--and I know I think--that bonding would become a consideration to take into account for a non-bf mom. Something to be aware of. That said, while I certainly tend to take bonding *somewhat* for granted with a bf mom, there have been a few where it was not so automatic....I guess I watch for signs of good bonding in all moms, but would be more on the alert with a bottle feeding mom because she is not encouraging the production of her hormones that promote bonding.

MOST moms, whatever their chosen method of feeding, do bond with their babies! Sometimes, tho, bottle feeders are not aware that bonding is served (and babies' physical and mental health in many ways) through close contact during feeding time (well, anytime)--and I've known many a bottle feeding mom to set up her baby w/a bottle propped somehow, even fairly early on, rather than holding the baby (or having someone else hold the baby) for feeding.

As for choosing against clients who choose against bf--well, it is just as much my right to choose clients as theirs to choose care. I would not judge them, just likely would feel we weren't a good match. The bf issue is just a 'tag', as it were--one of many possible signs telling me whether or not I'd be the right mw for someone (and comfy myself with the relationship). Yes, certainly there are various ways to control pp bleeding and promote uterine involution--and I for one do not have easy access to any of the pharmaceutical methods.

This is a sensitive issue for many, and I hope no one takes anyone's opinion too personally. We hbmws on the whole have tended to research breastfeeding more than other kinds of practitioners on the whole; we do tend to have strong feelings about the benefits of bf for babies, moms and the whole family, based on our studies as well as our experiences. That is our right, just as it is others' right to bottle feed or hospital birth, or other. And everyone has a right to preferences and boundaries--there are docs who refused me prenatal care because of my intention to UC; now you know there are also hbmws who might refuse care based on client choice to bottle feed. These are decisions 'in favor of' what we each believe is best--not decision 'against' someone who chooses differently.

[sevenkids]

I request that they at least try to give it a few days, and I'm very clear that it is much better, safer, and healthier for both of them if they nurse. I've rarely had the experience of a mom not wanting to breastfeed, even for a short time, but it has come up at least twice where mom absolutely refused to even intitiate nursing. One was a victim of profound sexual abuse (she had cigar burn scars all over her breasts and nipples, courtesy of her father) and immediately packed her breasts with ice and an Ace bandage. The other wouldn't even discuss it. Neither had bleeding issues. Some moms who are ambivilent about nursing give it a go for a few days or weeks, but stop shortly after, and some are surprised that they actually enjoy it and continue for years. One of my mamas didn't want to nurse her third baby at all, but agreed to give it a shot for 2 weeks. Her baby is almost three and she is pleasantly shocked that he's still nursing! She told me that if she had known how easy it was and how much more sleep she actually got with her first two, she would have nursed them, too.

I'd be very careful to make sure they knew where their fundus was supposed to be and how it should feel, and how to massage their fundus to keep the uterus firm, and that they do it every time they go to pee, and that they recognize what too much blood loss is. Maybe leave some methergine tablets if indicated. But I would not risk someone out or refuse to care for them if they flat out choose not to breastfeed.

I have a client right now who had her last baby at home but is birthing in hospital with me this time due to insurance issues. I was absolutely flabbergasted at our first interview when she told me about her birth plans - she doesn't want to touch or see the baby until it's "cleaned up" and wrapped and no breastfeeding at all. She wants the baby carried away directly and brought back washed and wrapped. I don't think I've ever met someone who planned a natural birth, much less a homebirth, who didn't want to even see the baby right after!

I recently attended a homebirth where mom refused to touch the baby until after she was bathed. She nagged me for about an hour about when was I going to bathe the baby and wouldn't touch her (just looked at her laying on her chest with her hands in the air and her nose skinned up, like, "Eeeew!"). I explained that we generally don't bathe the baby until 24 hours so the baby doesn't get chilled, but she wasn't having any of that. I just gave in and bathed her so she would hold her, and after she was washed and smelling like Johnson & Johnson, (and after mom took a shower so she could wash the "nasty baby gunk" off her) she and her family started fawning all over her, rubbing lotion on her skin, ooohing and aaahing about how good she smelled now that she was clean. It was a first for me!

[doctorjen]

Yeah, this mom was adament that I take the baby away immediately. We've compromised that I, or a family member if they are interested, will hold the baby in warm blankets until the cord stops pulsing/placenta is born because I'm not a fan of early cord clamping. This is her 4th child, third was a homebirth, and she has never seen or touched the baby until it was washed. I'm wondering if after this birth while I'm sitting around holding the baby she'll peek and realize that baby doesn't look so gross after all. Most newborns are just wet - maybe some vernix - but not the huge bloody mess I think people are expecting.

[Georgetown HB Mom]

Originally Posted by MsBlack

I guess I watch for signs of good bonding in all moms, but would be more on the alert with a bottle feeding mom because she is not encouraging the production of her hormones that promote bonding.

80% of women in this country give birth with an epidural. Epidural's have shown to cut off the natural hormones that promote bonding as well. So I think someone that chooses to have a natural birth will get the bonding hormones from birth. I am completely supportive of any woman who wants to BF and I expect the same respect for my decision to FF and my decision to care for a client in my midwife practice will have nothing to do with her decision on how she will feed her baby.

[jazzharmony]

Georgetown, are you asserting that formula is not sub-standard and inferior to breastmilk?
Do you believe that, as a midwife, you do not have a responsibility to make sure a client is fully informed of the fact that formula is *inferior* to breastmilk and that there are risks long and short term, to both mother and baby, should she *choose* to formula feed?

[MidwifeErika]

Originally Posted by Georgetown HB Mom

80% of women in this country give birth with an epidural. Epidural's have shown to cut off the natural hormones that promote bonding as well. So I think someone that chooses to have a natural birth will get the bonding hormones from birth.

Yes, but as a student you know that there are hormone that are released each and everytime a mom sits down and breastfeeds her baby.

I am not saying that a formula feeding mom can't bond with her child, but nature built in little hormone boosts of bonding with breastfeeding. I did formula feed one of mine and I do feel very, very bonded to her! Love her just as much as my other two who I practiced extended breastfeeding with, but I will not pretend that the other is a lie. It is healthier to both mom and baby to breastfeed. It promotes bonding. It doesn't matter that I chose to do something different than that with my first child, that doesn't change science.

[MsBlack]

georgetown--

See? There is a mw for everyone....those whom I would prefer not to serve for their refusal to bf, can surely find a mw like you--and I'm pretty sure that there are families who, for other reasons, would prefer me over you. Thus, we can all be happy. I am a LOT of things for a LOT of people--my fam, community and clients. I simply have no interest in, nor do i think it would be good for my health or anyone else's life, to try to be ALL things for ALL people.

Jazz and hotwings--thanks both of you for those recent remarks. ITA on all counts

[mwherbs]

in my quick reply I forgot that I would be thinking about breast infection as well--
and you know if I transfer a client and she gets pain management- I think about how are things going between her and the baby and doubly so because she did not have the birth she planned--

[mendomidwife]

I don't require that women do anything other than what they want to do and what they think is best for them.

Carla

[mendomidwife]

[QUOTE=MsBlack;10299150]georgetown--

See? There is a mw for everyone....those whom I would prefer not to serve for their refusal to bf, can surely find a mw like you--and I'm pretty sure that there are families who, for other reasons, would prefer me over you. Thus, we can all be happy. I am a LOT of things for a LOT of people--my fam, community and clients. I simply have no interest in, nor do i think it would be good for my health or anyone else's life, to try to be ALL things for ALL people.

Very true....I recently delivered a baby at home and afterwards they moved to a neighboring town. The local Pediatrician refused to care for the baby because they did not plan on vaccinating. The mom politely said no thanks and found someone else....

Carla

[jazzharmony]

As a homebirth client, I would assume that a midwife, being an advocate for mothers and babies, would clearly be an advocate for breastfeeding or anything else that is in the best interest of mother and child. That, imo, means truly informing her clent.

[fairydoula]

Originally Posted by JunipersMom

I have right in my beginning paperwork that I will not work with a family that is not committed to breastfeeding at least as long as in my care (6 weeks postpartum). It's so so so very important to me that I work very hard to keep mom and babe healthy - in and out of the uterus.

I just wanted to say I think that's awesome! : ) How are you feeling???

I like the idea of that.... there are other midwives who may be ok with a mom not BF but if you're a strong advocate and you let them know upfront, they have a choice to hire you or not.
hugs!
- Jen